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FrameBuilder.get=qsProxy||[];var i51594419102856=new FrameBuilder("51594419102856",false,"","<!DOCTYPE HTML PUBLIC \"-\/\/W3C\/\/DTD HTML 4.01\/\/EN\" \"http:\/\/www.w3.org\/TR\/html4\/strict.dtd\">\n<html class=\"supernova\"><head>\n<meta http-equiv=\"Content-Type\" content=\"text\/html; charset=utf-8\" \/>\n<link rel=\"alternate\" type=\"application\/json+oembed\" href=\"https:\/\/www.jotform.com\/oembed\/?format=json&amp;url=http%3A%2F%2Fwww.jotform.com%2Fform%2F51594419102856\" title=\"oEmbed Form\"><link rel=\"alternate\" type=\"text\/xml+oembed\" href=\"https:\/\/www.jotform.com\/oembed\/?format=xml&amp;url=http%3A%2F%2Fwww.jotform.com%2Fform%2F51594419102856\" title=\"oEmbed Form\">\n<meta property=\"og:title\" content=\"BPRE Agent Registration Form\" >\n<meta property=\"og:url\" content=\"http:\/\/www.jotform.co\/form\/51594419102856\" >\n<meta property=\"og:description\" content=\"Please click the link to complete this form.\">\n<link rel=\"shortcut icon\" href=\"https:\/\/cdn.jotfor.ms\/favicon.ico\">\n<meta name=\"viewport\" content=\"width=device-width, initial-scale=1.0, maximum-scale=1.0, user-scalable=0\" \/>\n<meta name=\"HandheldFriendly\" content=\"true\" \/>\n<title>BPRE Agent Registration Form<\/title>\n<link href=\"https:\/\/cdn.jotfor.ms\/static\/formCss.css?3.3.4857\" rel=\"stylesheet\" type=\"text\/css\" \/>\n<link type=\"text\/css\" rel=\"stylesheet\" href=\"https:\/\/cdn.jotfor.ms\/css\/styles\/nova.css?3.3.4857\" \/>\n<link type=\"text\/css\" media=\"print\" rel=\"stylesheet\" href=\"https:\/\/cdn.jotfor.ms\/css\/printForm.css?3.3.4857\" \/>\n<style type=\"text\/css\">\n    .form-label-left{\n        width:150px;\n    }\n    .form-line{\n        padding-top:12px;\n        padding-bottom:12px;\n    }\n    .form-label-right{\n        width:150px;\n    }\n    body, html{\n        margin:0;\n        padding:0;\n        background:rgba(55, 52, 52, 0.76);\n    }\n\n    .form-all{\n        margin:0px auto;\n        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!important;\n}\n\n#label_10 {\n    color : rgb(102, 51, 51);\n}\n\n#label_11 {\n    color : rgb(102, 51, 51);\n}\n\n#label_12 {\n    color : rgb(102, 51, 51);\n}\n\n#label_14 {\n    color : rgb(102, 51, 51);\n}\n\n#label_15 {\n    color : rgb(102, 51, 51);\n}\n\n#label_16 {\n    color : rgb(102, 51, 51);\n}\n\n#label_18 {\n    color : rgb(102, 51, 51);\n}\n\n#label_19 {\n    color : rgb(102, 51, 51);\n}\n\n#label_20 {\n    color : rgb(102, 51, 51);\n}\n\n#label_34 {\n    color : rgb(102, 51, 51);\n}\n\n#label_36 {\n    color : rgb(102, 51, 51);\n}\n\n#label_38 {\n    color : rgb(102, 51, 51);\n}\n\n#label_46 {\n    color : rgb(115, 115, 115);\n}\n\n\n    \/* Injected CSS Code *\/\n<\/style>\n\n<link type=\"text\/css\" rel=\"stylesheet\" href=\"https:\/\/cdn.jotfor.ms\/css\/responsive.css?3.3.4857\" \/>\n<script src=\"https:\/\/cdn.jotfor.ms\/js\/vendor\/jquery-1.8.0.min.js?v=3.3.4857\" type=\"text\/javascript\"><\/script>\n<script src=\"https:\/\/cdn.jotfor.ms\/js\/vendor\/maskedinput.min.js?v=3.3.4857\" type=\"text\/javascript\"><\/script>\n<script src=\"https:\/\/cdn.jotfor.ms\/js\/vendor\/jquery.maskedinput.min.js?v=3.3.4857\" type=\"text\/javascript\"><\/script>\n<script src=\"https:\/\/cdn.jotfor.ms\/static\/prototype.forms.js\" type=\"text\/javascript\"><\/script>\n<script src=\"https:\/\/cdn.jotfor.ms\/static\/jotform.forms.js?3.3.4857\" type=\"text\/javascript\"><\/script>\n<script type=\"text\/javascript\">\n var jsTime = setInterval(function(){try{\n   JotForm.jsForm = true;\n\n   JotForm.init(function(){\n      JotForm.setPhoneMaskingValidator( 'input_58_full', '####-###-###' );\n      JotForm.setInputTextMasking( 'input_63', '###########' );\n\tJotForm.clearFieldOnHide=\"disable\";\n    \/*INIT-END*\/\n});\n\n   clearInterval(jsTime);\n }catch(e){}}, 1000);\n\n   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<span class=\"ispan\" style=\"font-weight:bold;\">\n                    YOUR PERSONAL DETAILS\n                  <\/span>\n                <\/span>\n              <\/span>\n            <\/div>\n            <div class=\"null\">\n            <\/div>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_clear\" id=\"id_9\">\n        <div id=\"cid_9\" class=\"form-input-wide\">\n          <div style=\"clear:both;\" data-component=\"clear\">\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line jf-required\" data-type=\"control_fullname\" id=\"id_57\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_57\" for=\"first_57\">\n          Full Name\n          <span class=\"form-required\">\n            *\n          <\/span>\n        <\/label>\n        <div id=\"cid_57\" class=\"form-input jf-required\">\n          <div data-wrapper-react=\"true\">\n            <span class=\"form-sub-label-container\" style=\"vertical-align:top;\">\n              <input type=\"text\" id=\"first_57\" name=\"q57_fullName[first]\" class=\"form-textbox validate[required]\" size=\"10\" value=\"\" data-component=\"first\" required=\"\" \/>\n              <label class=\"form-sub-label\" for=\"first_57\" id=\"sublabel_first\" style=\"min-height:13px;\"> First Name <\/label>\n            <\/span>\n            <span class=\"form-sub-label-container\" style=\"vertical-align:top;\">\n              <input type=\"text\" id=\"last_57\" name=\"q57_fullName[last]\" class=\"form-textbox validate[required]\" size=\"15\" value=\"\" data-component=\"last\" required=\"\" \/>\n              <label class=\"form-sub-label\" for=\"last_57\" id=\"sublabel_last\" style=\"min-height:13px;\"> Last Name <\/label>\n            <\/span>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line jf-required\" data-type=\"control_phone\" id=\"id_58\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_58\" for=\"input_58_full\">\n          Mobile Number\n          <span class=\"form-required\">\n            *\n          <\/span>\n        <\/label>\n        <div id=\"cid_58\" class=\"form-input jf-required\">\n          <span class=\"form-sub-label-container\" style=\"vertical-align:top;\">\n            <input type=\"tel\" id=\"input_58_full\" name=\"q58_mobileNumber[full]\" data-type=\"mask-number\" class=\"mask-phone-number form-textbox validate[required, Fill Mask]\" autocomplete=\"off\" data-masked=\"true\" value=\"\" data-component=\"phone\" required=\"\" \/>\n            <label class=\"form-sub-label\" for=\"input_58_masked\" id=\"sublabel_masked\" style=\"min-height:13px;\">  <\/label>\n          <\/span>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_clear\" id=\"id_13\">\n        <div id=\"cid_13\" class=\"form-input-wide\">\n          <div style=\"clear:both;\" data-component=\"clear\">\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line jf-required\" data-type=\"control_address\" id=\"id_56\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_56\" for=\"input_56_addr_line1\">\n          Address\n          <span class=\"form-required\">\n            *\n          <\/span>\n        <\/label>\n        <div id=\"cid_56\" class=\"form-input jf-required\">\n          <table summary=\"\" class=\"form-address-table\" cellpadding=\"0\" cellspacing=\"0\">\n            <tbody>\n              <tr>\n                <td colspan=\"2\">\n                  <span class=\"form-sub-label-container\" style=\"vertical-align:top;\">\n                    <input type=\"text\" id=\"input_56_addr_line1\" name=\"q56_address[addr_line1]\" class=\"form-textbox validate[required] form-address-line\" value=\"\" data-component=\"address_line_1\" required=\"\" \/>\n                    <label class=\"form-sub-label\" for=\"input_56_addr_line1\" id=\"sublabel_56_addr_line1\" style=\"min-height:13px;\"> Street Address <\/label>\n                  <\/span>\n                <\/td>\n              <\/tr>\n              <tr>\n                <td colspan=\"2\">\n                  <span class=\"form-sub-label-container\" style=\"vertical-align:top;\">\n                    <input type=\"text\" id=\"input_56_addr_line2\" name=\"q56_address[addr_line2]\" class=\"form-textbox form-address-line\" size=\"46\" value=\"\" data-component=\"address_line_2\" required=\"\" \/>\n                    <label class=\"form-sub-label\" for=\"input_56_addr_line2\" id=\"sublabel_56_addr_line2\" style=\"min-height:13px;\"> Street Address Line 2 <\/label>\n                  <\/span>\n                <\/td>\n              <\/tr>\n              <tr>\n                <td width=\"50%\">\n                  <span class=\"form-sub-label-container\" style=\"vertical-align:top;\">\n                    <input type=\"text\" id=\"input_56_city\" name=\"q56_address[city]\" class=\"form-textbox validate[required] form-address-city\" size=\"21\" value=\"\" data-component=\"city\" required=\"\" \/>\n                    <label class=\"form-sub-label\" for=\"input_56_city\" id=\"sublabel_56_city\" style=\"min-height:13px;\"> Suburb <\/label>\n                  <\/span>\n                <\/td>\n                <td>\n                  <span class=\"form-sub-label-container\" style=\"vertical-align:top;\">\n                    <input type=\"text\" id=\"input_56_state\" name=\"q56_address[state]\" class=\"form-textbox validate[required] form-address-state\" size=\"22\" value=\"\" data-component=\"state\" required=\"\" \/>\n                    <label class=\"form-sub-label\" for=\"input_56_state\" id=\"sublabel_56_state\" style=\"min-height:13px;\"> State <\/label>\n                  <\/span>\n                <\/td>\n              <\/tr>\n              <tr>\n                <td width=\"50%\">\n                  <span class=\"form-sub-label-container\" style=\"vertical-align:top;\">\n                    <input type=\"text\" id=\"input_56_postal\" name=\"q56_address[postal]\" class=\"form-textbox form-address-postal\" size=\"10\" value=\"\" data-component=\"zip\" required=\"\" \/>\n                    <label class=\"form-sub-label\" for=\"input_56_postal\" id=\"sublabel_56_postal\" style=\"min-height:13px;\"> Post Code <\/label>\n                  <\/span>\n                <\/td>\n                <td>\n                  <span class=\"form-sub-label-container\" style=\"vertical-align:top;\">\n                    <select class=\"form-dropdown validate[required] form-address-country\" name=\"q56_address[country]\" id=\"input_56_country\" data-component=\"country\" required=\"\">\n                      <option value=\"\"> Please Select <\/option>\n                      <option value=\"United States\"> United States <\/option>\n                      <option value=\"Afghanistan\"> Afghanistan <\/option>\n                      <option value=\"Albania\"> Albania <\/option>\n                      <option value=\"Algeria\"> Algeria <\/option>\n                      <option value=\"American Samoa\"> American Samoa <\/option>\n                      <option value=\"Andorra\"> Andorra <\/option>\n                      <option value=\"Angola\"> Angola <\/option>\n                      <option value=\"Anguilla\"> Anguilla <\/option>\n                      <option value=\"Antigua and Barbuda\"> Antigua and Barbuda <\/option>\n                      <option value=\"Argentina\"> Argentina <\/option>\n                      <option value=\"Armenia\"> Armenia <\/option>\n                      <option value=\"Aruba\"> Aruba <\/option>\n                      <option value=\"Australia\"> Australia <\/option>\n                      <option value=\"Austria\"> Austria <\/option>\n                      <option value=\"Azerbaijan\"> Azerbaijan <\/option>\n                      <option value=\"The Bahamas\"> The Bahamas <\/option>\n                      <option value=\"Bahrain\"> Bahrain <\/option>\n                      <option value=\"Bangladesh\"> Bangladesh <\/option>\n                      <option value=\"Barbados\"> Barbados <\/option>\n                      <option value=\"Belarus\"> Belarus <\/option>\n                      <option value=\"Belgium\"> Belgium <\/option>\n                      <option value=\"Belize\"> Belize <\/option>\n                      <option value=\"Benin\"> Benin <\/option>\n                      <option value=\"Bermuda\"> Bermuda <\/option>\n                      <option value=\"Bhutan\"> Bhutan <\/option>\n                      <option value=\"Bolivia\"> Bolivia <\/option>\n                      <option value=\"Bosnia and Herzegovina\"> Bosnia and Herzegovina <\/option>\n                      <option value=\"Botswana\"> Botswana <\/option>\n                      <option value=\"Brazil\"> Brazil <\/option>\n                      <option value=\"Brunei\"> Brunei <\/option>\n                      <option value=\"Bulgaria\"> Bulgaria <\/option>\n                      <option value=\"Burkina Faso\"> Burkina Faso <\/option>\n                      <option value=\"Burundi\"> Burundi <\/option>\n                      <option value=\"Cambodia\"> Cambodia <\/option>\n                      <option value=\"Cameroon\"> Cameroon <\/option>\n                      <option value=\"Canada\"> Canada <\/option>\n                      <option value=\"Cape Verde\"> Cape Verde <\/option>\n                      <option value=\"Cayman Islands\"> Cayman Islands <\/option>\n                      <option value=\"Central African Republic\"> Central African Republic <\/option>\n                      <option value=\"Chad\"> Chad <\/option>\n                      <option value=\"Chile\"> Chile <\/option>\n                      <option value=\"China\"> China <\/option>\n                      <option value=\"Christmas Island\"> Christmas Island <\/option>\n                      <option value=\"Cocos (Keeling) Islands\"> Cocos (Keeling) Islands <\/option>\n                      <option value=\"Colombia\"> Colombia <\/option>\n                      <option value=\"Comoros\"> Comoros <\/option>\n                      <option value=\"Congo\"> Congo <\/option>\n                      <option value=\"Cook Islands\"> Cook Islands <\/option>\n                      <option value=\"Costa Rica\"> Costa Rica <\/option>\n                      <option value=\"Cote d&#x27;Ivoire\"> Cote d&#x27;Ivoire <\/option>\n                      <option value=\"Croatia\"> Croatia <\/option>\n                      <option value=\"Cuba\"> Cuba <\/option>\n                      <option value=\"Cyprus\"> Cyprus <\/option>\n                      <option value=\"Czech Republic\"> Czech Republic <\/option>\n                      <option value=\"Democratic Republic of the Congo\"> Democratic Republic of the Congo <\/option>\n                      <option value=\"Denmark\"> Denmark <\/option>\n                      <option value=\"Djibouti\"> Djibouti <\/option>\n                      <option value=\"Dominica\"> Dominica <\/option>\n                      <option value=\"Dominican Republic\"> Dominican Republic <\/option>\n                      <option value=\"Ecuador\"> Ecuador <\/option>\n                      <option value=\"Egypt\"> Egypt <\/option>\n                      <option value=\"El Salvador\"> El Salvador <\/option>\n                      <option value=\"Equatorial Guinea\"> Equatorial Guinea <\/option>\n                      <option value=\"Eritrea\"> Eritrea <\/option>\n                      <option value=\"Estonia\"> Estonia <\/option>\n                      <option value=\"Ethiopia\"> Ethiopia <\/option>\n                      <option value=\"Falkland Islands\"> Falkland Islands <\/option>\n                      <option value=\"Faroe Islands\"> Faroe Islands <\/option>\n                      <option value=\"Fiji\"> Fiji <\/option>\n                      <option value=\"Finland\"> Finland <\/option>\n                      <option value=\"France\"> France <\/option>\n                      <option value=\"French Polynesia\"> French Polynesia <\/option>\n                      <option value=\"Gabon\"> Gabon <\/option>\n                      <option value=\"The Gambia\"> The Gambia <\/option>\n                      <option value=\"Georgia\"> Georgia <\/option>\n                      <option value=\"Germany\"> Germany <\/option>\n                      <option value=\"Ghana\"> Ghana <\/option>\n                      <option value=\"Gibraltar\"> Gibraltar <\/option>\n                      <option value=\"Greece\"> Greece <\/option>\n                      <option value=\"Greenland\"> Greenland <\/option>\n                      <option value=\"Grenada\"> Grenada <\/option>\n                      <option value=\"Guadeloupe\"> Guadeloupe <\/option>\n                      <option value=\"Guam\"> Guam <\/option>\n                      <option value=\"Guatemala\"> Guatemala <\/option>\n                      <option value=\"Guernsey\"> Guernsey <\/option>\n                      <option value=\"Guinea\"> Guinea <\/option>\n                      <option value=\"Guinea-Bissau\"> Guinea-Bissau <\/option>\n                      <option value=\"Guyana\"> Guyana <\/option>\n                      <option value=\"Haiti\"> Haiti <\/option>\n                      <option value=\"Honduras\"> Honduras <\/option>\n                      <option value=\"Hong Kong\"> Hong Kong <\/option>\n                      <option value=\"Hungary\"> Hungary <\/option>\n                      <option value=\"Iceland\"> Iceland <\/option>\n                      <option value=\"India\"> India <\/option>\n                      <option value=\"Indonesia\"> Indonesia <\/option>\n                      <option value=\"Iran\"> Iran <\/option>\n                      <option value=\"Iraq\"> Iraq <\/option>\n                      <option value=\"Ireland\"> Ireland <\/option>\n                      <option value=\"Israel\"> Israel <\/option>\n                      <option value=\"Italy\"> Italy <\/option>\n                      <option value=\"Jamaica\"> Jamaica <\/option>\n                      <option value=\"Japan\"> Japan <\/option>\n                      <option value=\"Jersey\"> Jersey <\/option>\n                      <option value=\"Jordan\"> Jordan <\/option>\n                      <option value=\"Kazakhstan\"> Kazakhstan <\/option>\n                      <option value=\"Kenya\"> Kenya <\/option>\n                      <option value=\"Kiribati\"> Kiribati <\/option>\n                      <option value=\"North Korea\"> North Korea <\/option>\n                      <option value=\"South Korea\"> South Korea <\/option>\n                      <option value=\"Kosovo\"> Kosovo <\/option>\n                      <option value=\"Kuwait\"> Kuwait <\/option>\n                      <option value=\"Kyrgyzstan\"> Kyrgyzstan <\/option>\n                      <option value=\"Laos\"> Laos <\/option>\n                      <option value=\"Latvia\"> Latvia <\/option>\n                      <option value=\"Lebanon\"> Lebanon <\/option>\n                      <option value=\"Lesotho\"> Lesotho <\/option>\n                      <option value=\"Liberia\"> Liberia <\/option>\n                      <option value=\"Libya\"> Libya <\/option>\n                      <option value=\"Liechtenstein\"> Liechtenstein <\/option>\n                      <option value=\"Lithuania\"> Lithuania <\/option>\n                      <option value=\"Luxembourg\"> Luxembourg <\/option>\n                      <option value=\"Macau\"> Macau <\/option>\n                      <option value=\"Macedonia\"> Macedonia <\/option>\n                      <option value=\"Madagascar\"> Madagascar <\/option>\n                      <option value=\"Malawi\"> Malawi <\/option>\n                      <option value=\"Malaysia\"> Malaysia <\/option>\n                      <option value=\"Maldives\"> Maldives <\/option>\n                      <option value=\"Mali\"> Mali <\/option>\n                      <option value=\"Malta\"> Malta <\/option>\n                      <option value=\"Marshall Islands\"> Marshall Islands <\/option>\n                      <option value=\"Martinique\"> Martinique <\/option>\n                      <option value=\"Mauritania\"> Mauritania <\/option>\n                      <option value=\"Mauritius\"> Mauritius <\/option>\n                      <option value=\"Mayotte\"> Mayotte <\/option>\n                      <option value=\"Mexico\"> Mexico <\/option>\n                      <option value=\"Micronesia\"> Micronesia <\/option>\n                      <option value=\"Moldova\"> Moldova <\/option>\n                      <option value=\"Monaco\"> Monaco <\/option>\n                      <option value=\"Mongolia\"> Mongolia <\/option>\n                      <option value=\"Montenegro\"> Montenegro <\/option>\n                      <option value=\"Montserrat\"> Montserrat <\/option>\n                      <option value=\"Morocco\"> Morocco <\/option>\n                      <option value=\"Mozambique\"> Mozambique <\/option>\n                      <option value=\"Myanmar\"> Myanmar <\/option>\n                      <option value=\"Nagorno-Karabakh\"> Nagorno-Karabakh <\/option>\n                      <option value=\"Namibia\"> Namibia <\/option>\n                      <option value=\"Nauru\"> Nauru <\/option>\n                      <option value=\"Nepal\"> Nepal <\/option>\n                      <option value=\"Netherlands\"> Netherlands <\/option>\n                      <option value=\"Netherlands Antilles\"> Netherlands Antilles <\/option>\n                      <option value=\"New Caledonia\"> New Caledonia <\/option>\n                      <option value=\"New Zealand\"> New Zealand <\/option>\n                      <option value=\"Nicaragua\"> Nicaragua <\/option>\n                      <option value=\"Niger\"> Niger <\/option>\n                      <option value=\"Nigeria\"> Nigeria <\/option>\n                      <option value=\"Niue\"> Niue <\/option>\n                      <option value=\"Norfolk Island\"> Norfolk Island <\/option>\n                      <option value=\"Turkish Republic of Northern Cyprus\"> Turkish Republic of Northern Cyprus <\/option>\n                      <option value=\"Northern Mariana\"> Northern Mariana <\/option>\n                      <option value=\"Norway\"> Norway <\/option>\n                      <option value=\"Oman\"> Oman <\/option>\n                      <option value=\"Pakistan\"> Pakistan <\/option>\n                      <option value=\"Palau\"> Palau <\/option>\n                      <option value=\"Palestine\"> Palestine <\/option>\n                      <option value=\"Panama\"> Panama <\/option>\n                      <option value=\"Papua New Guinea\"> Papua New Guinea <\/option>\n                      <option value=\"Paraguay\"> Paraguay <\/option>\n                      <option value=\"Peru\"> Peru <\/option>\n                      <option value=\"Philippines\"> Philippines <\/option>\n                      <option value=\"Pitcairn Islands\"> Pitcairn Islands <\/option>\n                      <option value=\"Poland\"> Poland <\/option>\n                      <option value=\"Portugal\"> Portugal <\/option>\n                      <option value=\"Puerto Rico\"> Puerto Rico <\/option>\n                      <option value=\"Qatar\"> Qatar <\/option>\n                      <option value=\"Republic of the Congo\"> Republic of the Congo <\/option>\n                      <option value=\"Romania\"> Romania <\/option>\n                      <option value=\"Russia\"> Russia <\/option>\n                      <option value=\"Rwanda\"> Rwanda <\/option>\n                      <option value=\"Saint Barthelemy\"> Saint Barthelemy <\/option>\n                      <option value=\"Saint Helena\"> Saint Helena <\/option>\n                      <option value=\"Saint Kitts and Nevis\"> Saint Kitts and Nevis <\/option>\n                      <option value=\"Saint Lucia\"> Saint Lucia <\/option>\n                      <option value=\"Saint Martin\"> Saint Martin <\/option>\n                      <option value=\"Saint Pierre and Miquelon\"> Saint Pierre and Miquelon <\/option>\n                      <option value=\"Saint Vincent and the Grenadines\"> Saint Vincent and the Grenadines <\/option>\n                      <option value=\"Samoa\"> Samoa <\/option>\n                      <option value=\"San Marino\"> San Marino <\/option>\n                      <option value=\"Sao Tome and Principe\"> Sao Tome and Principe <\/option>\n                      <option value=\"Saudi Arabia\"> Saudi Arabia <\/option>\n                      <option value=\"Senegal\"> Senegal <\/option>\n                      <option value=\"Serbia\"> Serbia <\/option>\n                      <option value=\"Seychelles\"> Seychelles <\/option>\n                      <option value=\"Sierra Leone\"> Sierra Leone <\/option>\n                      <option value=\"Singapore\"> Singapore <\/option>\n                      <option value=\"Slovakia\"> Slovakia <\/option>\n                      <option value=\"Slovenia\"> Slovenia <\/option>\n                      <option value=\"Solomon Islands\"> Solomon Islands <\/option>\n                      <option value=\"Somalia\"> Somalia <\/option>\n                      <option value=\"Somaliland\"> Somaliland <\/option>\n                      <option value=\"South Africa\"> South Africa <\/option>\n                      <option value=\"South Ossetia\"> South Ossetia <\/option>\n                      <option value=\"South Sudan\"> South Sudan <\/option>\n                      <option value=\"Spain\"> Spain <\/option>\n                      <option value=\"Sri Lanka\"> Sri Lanka <\/option>\n                      <option value=\"Sudan\"> Sudan <\/option>\n                      <option value=\"Suriname\"> Suriname <\/option>\n                      <option value=\"Svalbard\"> Svalbard <\/option>\n                      <option value=\"Swaziland\"> Swaziland <\/option>\n                      <option value=\"Sweden\"> Sweden <\/option>\n                      <option value=\"Switzerland\"> Switzerland <\/option>\n                      <option value=\"Syria\"> Syria <\/option>\n                      <option value=\"Taiwan\"> Taiwan <\/option>\n                      <option value=\"Tajikistan\"> Tajikistan <\/option>\n                      <option value=\"Tanzania\"> Tanzania <\/option>\n                      <option value=\"Thailand\"> Thailand <\/option>\n                      <option value=\"Timor-Leste\"> Timor-Leste <\/option>\n                      <option value=\"Togo\"> Togo <\/option>\n                      <option value=\"Tokelau\"> Tokelau <\/option>\n                      <option value=\"Tonga\"> Tonga <\/option>\n                      <option value=\"Transnistria Pridnestrovie\"> Transnistria Pridnestrovie <\/option>\n                      <option value=\"Trinidad and Tobago\"> Trinidad and Tobago <\/option>\n                      <option value=\"Tristan da Cunha\"> Tristan da Cunha <\/option>\n                      <option value=\"Tunisia\"> Tunisia <\/option>\n                      <option value=\"Turkey\"> Turkey <\/option>\n                      <option value=\"Turkmenistan\"> Turkmenistan <\/option>\n                      <option value=\"Turks and Caicos Islands\"> Turks and Caicos Islands <\/option>\n                      <option value=\"Tuvalu\"> Tuvalu <\/option>\n                      <option value=\"Uganda\"> Uganda <\/option>\n                      <option value=\"Ukraine\"> Ukraine <\/option>\n                      <option value=\"United Arab Emirates\"> United Arab Emirates <\/option>\n                      <option value=\"United Kingdom\"> United Kingdom <\/option>\n                      <option value=\"Uruguay\"> Uruguay <\/option>\n                      <option value=\"Uzbekistan\"> Uzbekistan <\/option>\n                      <option value=\"Vanuatu\"> Vanuatu <\/option>\n                      <option value=\"Vatican City\"> Vatican City <\/option>\n                      <option value=\"Venezuela\"> Venezuela <\/option>\n                      <option value=\"Vietnam\"> Vietnam <\/option>\n                      <option value=\"British Virgin Islands\"> British Virgin Islands <\/option>\n                      <option value=\"Isle of Man\"> Isle of Man <\/option>\n                      <option value=\"US Virgin Islands\"> US Virgin Islands <\/option>\n                      <option value=\"Wallis and Futuna\"> Wallis and Futuna <\/option>\n                      <option value=\"Western Sahara\"> Western Sahara <\/option>\n                      <option value=\"Yemen\"> Yemen <\/option>\n                      <option value=\"Zambia\"> Zambia <\/option>\n                      <option value=\"Zimbabwe\"> Zimbabwe <\/option>\n                      <option value=\"other\"> Other <\/option>\n                    <\/select>\n                    <label class=\"form-sub-label\" for=\"input_56_country\" id=\"sublabel_56_country\" style=\"min-height:13px;\"> Country <\/label>\n                  <\/span>\n                <\/td>\n              <\/tr>\n            <\/tbody>\n          <\/table>\n        <\/div>\n      <\/li>\n      <li class=\"form-line jf-required\" data-type=\"control_email\" id=\"id_59\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_59\" for=\"input_59\">\n          Email address\n          <span class=\"form-required\">\n            *\n          <\/span>\n        <\/label>\n        <div id=\"cid_59\" class=\"form-input jf-required\">\n          <input type=\"email\" id=\"input_59\" name=\"q59_emailAddress\" class=\"form-textbox validate[required, Email]\" size=\"50\" value=\"\" placeholder=\" \" data-component=\"email\" required=\"\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_clear\" id=\"id_17\">\n        <div id=\"cid_17\" class=\"form-input-wide\">\n          <div style=\"clear:both;\" data-component=\"clear\">\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_clear\" id=\"id_21\">\n        <div id=\"cid_21\" class=\"form-input-wide\">\n          <div style=\"clear:both;\" data-component=\"clear\">\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line jf-required\" data-type=\"control_textbox\" id=\"id_64\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_64\" for=\"input_64\">\n          Name of your Business\n          <span class=\"form-required\">\n            *\n          <\/span>\n        <\/label>\n        <div id=\"cid_64\" class=\"form-input jf-required\">\n          <input type=\"text\" id=\"input_64\" name=\"q64_nameOf\" data-type=\"input-textbox\" class=\"form-textbox validate[required, AlphaNumeric]\" size=\"30\" value=\"\" placeholder=\" \" data-component=\"textbox\" required=\"\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line jf-required\" data-type=\"control_textbox\" id=\"id_65\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_65\" for=\"input_65\">\n          What type of Business Licence do you have?\n          <span class=\"form-required\">\n            *\n          <\/span>\n        <\/label>\n        <div id=\"cid_65\" class=\"form-input jf-required\">\n          <input type=\"text\" id=\"input_65\" name=\"q65_whatType\" data-type=\"input-textbox\" class=\"form-textbox validate[required, AlphaNumeric]\" size=\"30\" value=\"\" placeholder=\" \" data-component=\"textbox\" required=\"\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_textbox\" id=\"id_66\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_66\" for=\"input_66\"> Licence Number <\/label>\n        <div id=\"cid_66\" class=\"form-input\">\n          <input type=\"text\" id=\"input_66\" name=\"q66_licenceNumber\" data-type=\"input-textbox\" class=\"form-textbox validate[AlphaNumeric]\" size=\"30\" value=\"\" placeholder=\" \" data-component=\"textbox\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line jf-required\" data-type=\"control_textbox\" id=\"id_63\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_63\" for=\"input_63\">\n          ABN number\n          <span class=\"form-required\">\n            *\n          <\/span>\n        <\/label>\n        <div id=\"cid_63\" class=\"form-input jf-required\">\n          <input type=\"text\" id=\"input_63\" name=\"q63_abnNumber\" data-type=\"input-textbox\" class=\"form-textbox validate[required, Numeric]\" size=\"11\" data-masked=\"true\" value=\"\" placeholder=\" \" data-component=\"textbox\" required=\"\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_separator\" id=\"id_52\">\n        <div id=\"cid_52\" class=\"form-input-wide\">\n          <div data-component=\"separator\" style=\"border-top:4px solid rgb(255, 85, 0);clear:both;\">\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_clear\" id=\"id_27\">\n        <div id=\"cid_27\" class=\"form-input-wide\">\n          <div style=\"clear:both;\" data-component=\"clear\">\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_clear\" id=\"id_29\">\n        <div id=\"cid_29\" class=\"form-input-wide\">\n          <div style=\"clear:both;\" data-component=\"clear\">\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_text\" id=\"id_32\">\n        <div id=\"cid_32\" class=\"form-input-wide\">\n          <div id=\"text_32\" class=\"form-html\" data-component=\"text\">\n            <div class=\"staticcontrol\">\n              <span class=\"wordwrap\">\n                <span class=\"pspan verdana\" style=\"font-size:18px;\">\n                  <span class=\"ispan\" style=\"font-weight:bold;\">\n                    YOUR USER NAME DETAILS\n                  <\/span>\n                <\/span>\n              <\/span>\n            <\/div>\n            <div class=\"null\">\n            <\/div>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_clear\" id=\"id_33\">\n        <div id=\"cid_33\" class=\"form-input-wide\">\n          <div style=\"clear:both;\" data-component=\"clear\">\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line jf-required\" data-type=\"control_textbox\" id=\"id_60\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_60\" for=\"input_60\">\n          Provide a User Name\n          <span class=\"form-required\">\n            *\n          <\/span>\n        <\/label>\n        <div id=\"cid_60\" class=\"form-input jf-required\">\n          <input type=\"text\" id=\"input_60\" name=\"q60_provideA\" data-type=\"input-textbox\" class=\"form-textbox validate[required]\" size=\"30\" value=\"\" placeholder=\" \" data-component=\"textbox\" required=\"\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_clear\" id=\"id_35\">\n        <div id=\"cid_35\" class=\"form-input-wide\">\n          <div style=\"clear:both;\" data-component=\"clear\">\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line jf-required\" data-type=\"control_textbox\" id=\"id_61\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_61\" for=\"input_61\">\n          I was Referred By\n          <span class=\"form-required\">\n            *\n          <\/span>\n        <\/label>\n        <div id=\"cid_61\" class=\"form-input jf-required\">\n          <input type=\"text\" id=\"input_61\" name=\"q61_iWas\" data-type=\"input-textbox\" class=\"form-textbox validate[required]\" size=\"30\" value=\"\" placeholder=\" \" data-component=\"textbox\" required=\"\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_clear\" id=\"id_37\">\n        <div id=\"cid_37\" class=\"form-input-wide\">\n          <div style=\"clear:both;\" data-component=\"clear\">\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_textarea\" id=\"id_62\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_62\" for=\"input_62\"> Comments <\/label>\n        <div id=\"cid_62\" class=\"form-input\">\n          <textarea id=\"input_62\" class=\"form-textarea\" name=\"q62_comments\" cols=\"40\" rows=\"6\" data-component=\"textarea\"><\/textarea>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_clear\" id=\"id_39\">\n        <div id=\"cid_39\" class=\"form-input-wide\">\n          <div style=\"clear:both;\" data-component=\"clear\">\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_clear\" id=\"id_41\">\n        <div id=\"cid_41\" class=\"form-input-wide\">\n          <div style=\"clear:both;\" data-component=\"clear\">\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_separator\" id=\"id_42\">\n        <div id=\"cid_42\" class=\"form-input-wide\">\n          <div data-component=\"separator\" style=\"border-top:4px solid rgb(255, 85, 0);clear:both;\">\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_clear\" id=\"id_43\">\n        <div id=\"cid_43\" class=\"form-input-wide\">\n          <div style=\"clear:both;\" data-component=\"clear\">\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_clear\" id=\"id_45\">\n        <div id=\"cid_45\" class=\"form-input-wide\">\n          <div style=\"clear:both;\" data-component=\"clear\">\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line jf-required\" data-type=\"control_checkbox\" id=\"id_46\">\n        <label class=\"form-label form-label-top\" id=\"label_46\" for=\"input_46_0\">\n          NOTE: Access to the BPRE Agent Portal is provided by invitation only. BPRE is a fully licensed Real Estate Agency representing property developers and property vendors under strict confidentiality agreements. By registering and using the BPRE Agent Portal you agree to the terms and conditions of use. The information displayed in the Agent Portal is private and confidential and subject to intellectual property and copyright. We ask that you do not share the portal login credentials with other 3rd parties. Once your user account has been activated you will receive an email with your login credentials. I have read the BPRE terms and conditions of use and privacy policy and I agree with its terms of use.\n          <span class=\"form-required\">\n            *\n          <\/span>\n        <\/label>\n        <div id=\"cid_46\" class=\"form-input-wide jf-required\">\n          <div class=\"form-single-column\" data-component=\"checkbox\">\n            <span class=\"form-checkbox-item\" style=\"clear:left;\">\n              <span class=\"dragger-item\">\n              <\/span>\n              <input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_46_0\" name=\"q46_iHave46[]\" value=\"Please tick box if you agree\" required=\"\" \/>\n              <label id=\"label_input_46_0\" for=\"input_46_0\"> Please tick box if you agree <\/label>\n            <\/span>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_clear\" id=\"id_47\">\n        <div id=\"cid_47\" class=\"form-input-wide\">\n          <div style=\"clear:both;\" data-component=\"clear\">\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_separator\" id=\"id_48\">\n        <div id=\"cid_48\" class=\"form-input-wide\">\n          <div data-component=\"separator\" style=\"border-top:1px dotted rgb(128, 64, 64);clear:both;\">\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_clear\" id=\"id_49\">\n        <div id=\"cid_49\" class=\"form-input-wide\">\n          <div style=\"clear:both;\" data-component=\"clear\">\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_clear\" id=\"id_51\">\n        <div id=\"cid_51\" class=\"form-input-wide\">\n          <div style=\"clear:both;\" data-component=\"clear\">\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_clear\" id=\"id_53\">\n        <div id=\"cid_53\" class=\"form-input-wide\">\n          <div style=\"clear:both;\" data-component=\"clear\">\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_button\" id=\"id_54\">\n        <div id=\"cid_54\" class=\"form-input-wide\">\n          <div style=\"margin-left:156px;\" class=\"form-buttons-wrapper\">\n            <button id=\"input_54\" type=\"submit\" class=\"form-submit-button\" data-component=\"button\">\n              Submit\n            <\/button>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li style=\"display:none\">\n        Should be Empty:\n        <input type=\"text\" name=\"website\" value=\"\" \/>\n      <\/li>\n    <\/ul>\n  <\/div>\n  <script>\n  JotForm.showJotFormPowered = \"0\";\n  <\/script>\n  <input type=\"hidden\" id=\"simple_spc\" name=\"simple_spc\" value=\"51594419102856\" \/>\n  <script type=\"text\/javascript\">\n  document.getElementById(\"si\" + \"mple\" + \"_spc\").value = \"51594419102856-51594419102856\";\n  <\/script>\n<\/form><\/body>\n<\/html>\n","BPRE Agent Registration Form",Array,0);(function(){window.handleIFrameMessage=function(e){if(!e.data||!e.data.split)return;var args=e.data.split(":");var iframe=document.getElementById("51594419102856");if(!iframe){return};switch(args[0]){case"scrollIntoView":if(!("nojump"in FrameBuilder.get)){iframe.scrollIntoView();}
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